NEHA November 2022 Journal of Environmental Health

November 2022 • Journal of Environmental Health 23 of Guernsey, Sweden, the UK, and the U.S. (Noh et al., 2022a; Ra et al., 2019; Sendesi et al., 2020). Only recently have emergency responders received guidance on CIPP operations (Noh et al., 2022a). As health o„cials have begun to formally respond to and collaborate regarding CIPP health concerns (California Department of Public Health, 2018; Florida Department of Public Health, 2020; LeBouf & Burns, 2019; LeBouf et al., 2021; WDHFS & ATSDR, 2005), evidencebased information is needed for planning and response activities (See Supplemental SI-1 at The goal of our study was to identify and assess public environmental and occupational health knowledge gaps associated with CIPP use. Specific objectives were to 1) conduct a literature review of current materials, practices, and regulations associated with waste discharge and 2) identify and prioritize research needs through a work group of government agencies and health associations. Our study results are intended to assist o„cials in understanding the chemicals, exposure pathways, and actions needed to make data-driven health protection decisions. Methods Literature Review and Approach We reviewed CIPP-related peer-reviewed journal articles, gray literature, industry and government reports, and emergency responder incident reports. The review focused on five topics: 1) plastic manufacture and wastes, 2) sewers and buildings, 3) chemical exposure and health e›ects, 4) quantitative chemical risk assessment, and 5) risk communication (Supplemental Figure 1). Information obtained was used as the basis for work group discussions. Work Group Formation, Approach, and Research Team Dialogue To identify existing public health knowledge gaps related to the CIPP procedure, six work group meetings were convened virtually between February 8 and May 10, 2021. More than 30 representatives from 13 U.S. federal, state, and city health agencies as well as public health associations participated (Supplemental Figure 1). Participants included environmental health specialists, toxicologists, epidemiologists, occupational health scientists, and emergency response specialists. Each meeting began with a presentation by a subject matter expert outlining current knowledge about a specific topic (30 min), followed by group discussion (30 min). During meetings, participants asked questions, shared their own CIPP knowledge and experiences, and discussed existing evidence and information gaps. Each meeting resulted in the identification of key messages for CIPPrelated hazards, exposure assessment, and environmental health. The final meeting focused on potential public health risks, practices, and guidelines. After work group activities, the authors distilled the information to prioritize a public health action plan with the American Public Health Association, Association of State and Territorial Health O„cials, and National Environmental Health Association. Results Practice, Pollutants, and Risk Cured-in-Place Pipe Practices Many engineering and construction entities are involved in the proposal, conduct, and oversight of CIPP construction projects (Supplemental SI-2). Under a single project, multiple CIPPs can be manufactured in a single sewer system. To manufacture a CIPP, raw materials such as uncured resin with volatile organic compounds (VOCs) and semivolatile organic compounds (SVOCs) are delivered to the work site. An uncured tube of resin is then inflated against the wall of the damaged existing pipe (Supplemental Table 1). CIPP contractors inject air, steam, or water to keep the uncured resin tube pressed against the pipe wall during setup, curing, and cool down periods. For steam, pressures range from 20 to 552 kPa (3 to 80 psi). Different curing methods are used to polymerize uncured resin into a hard plastic; steam is the most popular method while hot water is applied in another method. Curing with UV light is the least popular due to its higher cost. Lastly, the ends of the new hard plastic are cut, and the contractor relocates to the next CIPP manufacturing site. Chemicals Brought, Chemicals Created Resin constituents and degradation products can be released into the air before, during, and after manufacture (Matthews et al., 2020; Noh et al., 2022b; Ra et al., 2018, 2019; Example of How Plastic Cured-in-Place Pipes (CIPPs) Are Manufactured Inside Damaged Pipes Within Neighborhoods Next to Roadways FIGURE 1